Lyndon B. Johnson & the Creation of Medicare

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Lyndon B. Johnson & the Creation
of Medicare
Jonathan Flug MD, MBA
Winthrop University Hospital
Mineola, NY
History of Pooled Insurance
• Ancient Greek funeral societies
– Pooled resources to cover funeral costs
• Idea of government supported healthcare also
goes back to ancient Greek city-states
– Tax-supported public physicians
• Germany & Bismarck became the first modern
nation to adopt an old-age social program in
1889
– Chose an age of 70 for eligibility, later
lowered to 65
President Franklin Delano Roosevelt
(President 1933-1945)
• 1934 – FDR considered including universal
medical benefits to original Social Security Act
– Highly unpopular and removed from final bill
– The Act empowered the Social Security Board to
study “related” areas, and the board drafted a
committee to explore government sponsored
healthcare for all
President Franklin Delano Roosevelt
(President 1933-1945)
• Healthcare legislation was then introduced in
almost every congressional session after 1939.
– First bill by Senators Wagner (D., N.Y.), Murray
(D., Mont.), & Dingell (D., Mich.)
– Early legislation attempted to incorporate
healthcare into social security
– Legislative efforts went nowhere
– Strong opposition from many groups, including
AMA and Republicans
President Harry Truman
(President 1945-1953)
• After WWII, Truman fought strongly for universal
government insurance
• 1945 – Submitted the first ever presidential message
devoted exclusively to health care
• 1950 – Democrats suffered substantial losses in
Congress. Proponents felt universal health coverage
would never be realized
– Proposals restructured earlier proposals to only
include elderly, Social Security recipients
President Dwight D. Eisenhower
(President 1953-1961)
• As a Republican, he strongly opposed government
health insurance
• Proposed bills for government healthcare for the
elderly encountered strong opposition
• 1956 – Disability insurance added to Social Security
– Considered an incremental advance
• 1960 – Congress passes Kerr-Mills Bill
– Provided medical aid for the aged poor. Passed with the
hope it would act as a concession and thwart further
governmental health insurance proposals.
President John F. Kennedy
(President 1961-1963)
• Renewed presidential interest in government
healthcare for the elderly
• 1962 – Supported the King-Anderson bill,
which would have provided hospital coverage
for seniors under Social Security
– Blocked by Mills, a conservative Democrat in the
House Ways & Means Committee
President Lyndon B. Johnson
(President 1963-1969)
• 1964 - Democratic President, Lyndon B. Johnson along
with huge democratic majorities in the house and
senate:
– Believed healthcare to be integral to Great Society Program
– At this time, only 55% of seniors had health insurance
• Mills changes his views, and supports Medicare
– Historically given credit for passage of the bill
– LBJ minimized his own role, leaving details and credit to
Congress to expedite passage as evidenced by recorded
phone calls recently released by the
White House
President Lyndon B. Johnson
(President 1963-1969)
• H.R. 1 & S. 1 introduced as first bills in each House of the
New Congress
• Those who initially opposed the bill switched focus to
help create new, amended versions of it
– Medicare Version – provided coverage of the aged, limited
hospitalization & nursing home insurance benefits
– AMA Version – Eldercare. Government financing for physicians
services, surgical charges, drugs, nursing home costs, x-ray &
lab services
– Congressman Byrnes’ Version – financing of doctors’ services
and drugs. Voluntary participation.
President Lyndon B. Johnson
(President 1963-1969)
• Final bill combined the proposals
• New program would be an extension of Social
Security, adding 2 amendments
– Title XVIII – Medicare – includes Part A & B
• Part A – Hospital coverage for the elderly
• Part B – Supplementary medical insurance
– Title XIX – Medicaid
• Provides for states to finance healthcare for
the poor with matching federal funds
President Lyndon B. Johnson
(President 1963-1969)
• July 30, 1965 – Medicare Bill signed by President
Johnson. Former President Harry Truman is the first
Medicare enrollee.
To Read More On This Topic…
• Centers for Medicare website
– Excellent history section with historic speeches,
documents, and a Medicare quiz.
– https://www.cms.gov/History
– https://www.cms.gov/History/Downloads/QUIZ08.pd
• Blumenthal, et al. The Lessons of Success –
Revisiting the Medicare Story
– An interesting article describing how a President should
approach healthcare reform
References
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4.
“Social Security Act of 1965.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation,
Inc. 22 July 2004. Web. 1 Oct 2011.
http://en.wikipedia.org/wiki/Social_Security_Act_of_1965
Dewiit L. The medicare program as a capstone to the great society – recent revelations in
the LBJ White House tapes. http://www.larrydewitt.net/Essays/MedicareDaddy.htm
“Lyndon B. Johnson.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. 22 July
2004. Web. 1 Oct 2011. http://en.wikipedia.org/wiki/Lyndon_B._Johnson
Blumenthal D, Morone J. The lessons of success – revisiting the medicare story. NEJM
2008;359:2384-2389.